Spotlight on People

In May and June 2016, IAPHL held a discussion called “Shining the Spotlight on People.” 

Summary of Week 1 discussion

The question for the first week was: What is really going on with human resources in my supply chain? Is it really just a lack of capacity? Or is it know/don’t do, know/can’t do, or know/won’t do? And if the latter, what are the reasons behind noncompliance? What would enable good performance and compliance?

The discussion was moderated by Dominique Zwinkels, Executive Manager, People that Deliver.

We know that when supply chain challenges are assessed, a lack of human resource capacity is at least partially blamed. And almost always, the solution proffered is more training. But is a lack of capacity really the problem? Are we saying that logisticians, pharmacists, doctors, and nurses who have advanced degrees and must constantly improvise to save lives in suboptimal circumstances are incapable of completing basic supply functions like entering information into a stock register?

Performance-hindering factors and performance-enhancing suggestions:

• Workload and not understanding the roles, not appreciating that supply chain (SC) is part of the core function and not just an additional task.
• Performance management systems that ensure reward, accountability, and feedback are not applied. There is little or no motivation for growth.
• We need a systematic HR development plan.
• Our systems favor degrees over know how/expertise and individual behavior. There needs to be a better awareness of inter-dependencies along the supply chain and clear definition of responsibilities
• Supply chain activities only become important when health facilities experience stockouts.
• Priorities: clinicians are busy people who are used to seeing quick results and immediate value in the treatment and health services they provide. Stock management is always an afterthought.
• Supply chain training tends to be too narrow, focusing on very specific tasks, e.g., inventory management. Training should have a broader viewpoint and highlight inter-dependencies in the SC and should focus on soft skills, e.g., leadership and problem solving.
• Lack of national policy governing HR issues. The HR for SC management plan needs to be aligned with national human resources for health policies.
• Governments have a responsibility for making medicines, vaccines, and other health commodities available and accessible to everyone. But this does not mean that governments should be operating supply chains or employing supply chain workers.
• The government cannot increase salaries for health workers without doing the same for other government workers.
• Unmotivated staff.
• Remuneration and its effect on staff motivation and morale.
• Need to take into account the financial management methods, including PBF and cost-recovery models.
• Workload and multiplicity of paper-based reporting tools/systems require intense labor and take away from other core responsibilities.
• At what point would service delivery or technical personnel consider capacity-building activities such as training, support, supervisory visits, and mentoring, be enough or adequate? Probably never!
• Supervisors should encourage creativity and initiative.
• This great domestic analogy is used to train nurses: How many days will the available salt, sugar, and rice that I have in my kitchen last before I run out? Do I wait for it to finish before I buy more? Do I buy daily at the little corner shop or do I wait for market day and buy in bulk from the traders who come from the town? These questions are also relevant to SC management.
• Empower nurses/health workers at peripheral levels to perform SC functions.
• SC management is not generally included in nurses’ training but nurses understand the importance of commodities management to ensure uninterrupted delivery of services.
• Good working conditions attract and retain superior staff. Offer well-paid senior positions. Show staff respect first and ask for results and accountability second.
• Give supply chain managers a seat at the decisions makers’ table.
• Give SC managers authority to motivate and sanction staff accordingly.
• Some people attend the same or similar training several times yet never improve. Select the right participants for training and only issue certificate of completion when there is evidence that what was taught in the training is actually being applied in the workplace.
• After-training reward and recognition systems can motivate staff to perform better. Likewise, systems to penalize non-compliant staff should be in place.
• Emphasize mentoring. Any meaningful public health program should include a robust supply chain capacity-building program that matches the private sector
• Segregate functions and hire a logistics firm to maintain supplies at the health facilities.
• Review the design of the supply chain and how it affects the work of nurses at district hospitals and health centers. In some situations, nurses much fetch commodities from the district or health zone level, which reduces the amount of time they have to provide clinical care. Good models include the informed push system in Senegal for family planning products, and informed push systems in Benin and Mozambique for vaccines.
• In France, the government engaged private-sector pharmacists at district level. In Burkina Faso it increased positions and budget allocations for district-level pharmacists, who also supervise health centers.
• Partnership between public and private sectors, as seen in Senegal, whose government provides strong oversight and gives private providers incentives to ensure consistent last-mile access to commodities.
• Encourage health care workers to take more interest in what’s going on in their supply rooms. National and community health insurance schemes—increasingly seen as essential to achieving universal health coverage—must be structured to encourage good health outcomes, not just pay for health inputs. Good example from Romania.
• We need adequate supply chain officers at every level and in particular district, provincial, and regional pharmacists. We need logisticians, pharmacy technicians, and dispensary and pharmacy assistants who are well-trained and -motivated to manage an effective supply chain.
• And finally leadership in the supply chain, which many developing countries lack.

Summary of Week 2 discussion

The question for the second week was: How do we develop the leadership skills, technical and management competencies required to manage a supply chain effectively?

The discussion was moderated by Abre Van Buuren, Manager, Africa Supply Chain Academy, Imperial Health Sciences and Dominique Zwinkels, Executive Manager, People that Deliver

An underlying theme in the four examples and country experiences was that public health supply chains remain a low priority for health authorities. Contributing to this is the strong dependence on external sources of financing, which undermines the supply chain. But authorities must be committed if we are to find solutions to the major challenges in supply chain management. While staff in charge of supply chains need training, many of the problems are beyond staff training. Managers responsible for resources at health facilities are often not in official positions. And until recently, supply chains were not well-positioned within operational structures, and as a result, individuals with a variety of qualifications (but not supply chain) managed the public health supply chain.

All supply chain roles and responsibilities must be clearly defined to create a framework for exchange of good practices on supply chain management. For instance, when nurses are recognized as leaders, teams are mobilized, agreements are made on pricing, and there are fewer stockouts and overstocks. Product availability improves use of services, and in turn, generates the revenue needed for continued existence.

A key strategy to develop leadership skills is the peer learning approach, which builds competencies to manage a public health supply chain effectively. Private sector involvement in public health supply chain leadership development has been effective in many African countries. There are material and financial benefits to all involved: the community gains better access to products and health districts gain revenue.

Summary of Week 3 discussion

The question for the third week was: Besides training, how can we implement all components of a comprehensive human resources development plan that will address all public health supply chain management HR issues?

This discussion was moderated by Abre Van Buuren, Manager, Africa Supply Chain Academy, Imperial Health Sciences and Ruby Headley, Supply Chain Specialist, UPS/Gavi.

• We need an assessment guide and tool for HR capacity development in public health supply chain management. Such a tool already exists, thanks to the USAID | DELIVER PROJECT in collaboration with the People that Deliver (PtD)!
• In countries where this assessment tool was used, universities and other teachings institutes now offer supply chain management.
• Health ministries must make provision for a professional recognition of the SC function at national level.
• Talent retention is a problem because trained staff tends to migrate from the public health sector to better-paying jobs.
• Monetary remuneration alone cannot fix the talent erosion. It must be combined with other motivation tools such as performance-based bonus, promotions, and recognition.
• Need to develop work aids such as SOPs and job descriptions to help personnel determine their roles and relevance.
• On-the-job training is the tool of choice for most SC functions.
• Make use of available resources such as PtD, MSH, Empower School of Health, and IAPHL to improve and strengthen existing knowledge and skills.
• Training in management type soft skills such as leadership skills is sorely needed (e.g., Nigeria).
• Hiring management-level SC staff is a lengthy and time-consuming process in certain countries (e.g., India).
• The few answers to the question about privatizing the SCM in public health were “not the entire SC” but “certain functions,” “let the experts handle the functions they do best!”
• Because of the complexities and challenges of SCM in public health, governments should consider a PPP (private public partnership) model to leverage the private sector promising practices and experiences (e.g., how can Coca Cola reach areas that are inaccessible to the SCM?)
• Einstein allegedly said that “The definition of insanity is doing the same thing over and over again, but expecting different results.” We will not go as far as to compare the handling of SCM in most countries as an insane endeavor, but one can only wonder why it is so hard to combine all the ingredients of a comprehensive HR management plan into an enticing recipe for public health consumption in supply chain management?